Provider Demographics
NPI:1043260086
Name:FRIZE, ROSINA BURNIS (PA)
Entity Type:Individual
Prefix:MS
First Name:ROSINA
Middle Name:BURNIS
Last Name:FRIZE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5059 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1713
Mailing Address - Country:US
Mailing Address - Phone:323-344-4144
Mailing Address - Fax:323-344-4146
Practice Address - Street 1:5059 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1713
Practice Address - Country:US
Practice Address - Phone:323-344-4144
Practice Address - Fax:323-344-4146
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP99649Medicare UPIN